Teaching Students and Nurses Evidence-Based Recommendations for Culturally Sensitive Perinatal Care of Somali Immigrant Women

Nursing education should provide students and nurses with knowledge to meet the current healthcare needs of all groups within society, including immigrant populations. Research allows the direct acquisition of information that can then transform education and subsequently improve practice. Because of the diaspora of the Somali people which began in the 1990s, there is a large immigrant Somali population in the United States (Warfa et al., 2012).  In Somalia, the cultural mores include the value of large families and there is a strong social support for 40 days after childbirth (Binder, Johnsdotter, & Essén, 2013). This social support is usually absent for the immigrant new mother. There is a need for nurses to understand and to provide for the special needs of this community, specifically new mothers.

Leininger’s Cultural Care and Universality Theory (McFarland, & Wehbe-Alamah,  2014) provides a framework for both research and practice related to culturally sensitive care and was the basis of a qualitative study of Somali immigrant new mothers’ experience of childbirth. Semi-structured interviews with 12 new Somali immigrant mothers in a Midwestern metropolitan area were conducted.  Examples of interview questions include the following: “Describe your birth experience,” “What cultural and religious beliefs and practices helped you to become a new mother?” Data analysis began with the first interview and continued in-depth to discover recurrent patterns of ideas, expressions, or explanations until saturation was reached. Analysis resulted in  the following findings: the limitations of support due to separation from family, the importance of cultural and religious beliefs and practices, the desired relationships with nurses, the fear of Cesarean section, and views on postpartum blues/depression. After identified findings were confirmed by a Somali cultural expert and participants, recommendations for future nursing research, practice, and education were formulated.

The findings from this study provide evidence that should be integrated into nursing education and practice. Recommendations for faculty, clinical educators, and staff nurses include awareness of  the loss of support a Somali immigrant new mother experiences during the 40-day period following childbirth. Due to this loss nurses need to determine and provide information on available social support resources.  Interventions that nurses can implement in caring for Somali new mothers include being aware of the husband’s call to prayer in the newborn’s ears, facilitating Somali women to eat authentic food, and promoting family and community support. Nurses should go beyond performing tasks and establish trusting relationships with new Somali mothers. One of the most important actions that nurses should take is to initiate and maintain a dialogue with a new mother, ensuring that the woman is not isolated emotionally. Another recommendation is acknowledging that the immigrant Somali husband has a new support role in the US and should be included in pre- and postnatal teaching. Additionally, due to the specific fear of Cesarean section among Somali women, nurses should acknowledge this and discuss implications of Cesarean section. Because of the presence of postpartum blues and postpartum depression in immigrant Somali new mothers, this topic should be purposefully discussed.

Further research is recommended to study postpartum blues and postpartum depression in immigrant Somali women, the impact of education on the fear of Cesarean section, and the evolving new role of the Somali husband during the perinatal period. Recommendations for undergraduate, graduate, and continuing nursing education include teaching the value and specifics of culturally sensitive care for Somali immigrant women. The future of nursing education and practice depends on culturally sensitive care to our diverse and ever-changing patient population.